Surgical management of delayed union and nonunion of distal radius fractures

Ten patients with malaligned fractures of the distal radius that demonstrat ed either delayed healing or the development of an atrophic or synovial non union on standard radiographs were treated with surgical realignment, stabl e internal fixation, and autogenous iliac crest bone grafting. All 10 fract ures healed with acceptable radiologic alignment within 3 months of the ind ex procedure. After an average follow-up period of 3 years 6 months (range, 2 years to 8 years 6 months) patients had an average of 105 degrees wrist flexion and extension, 145 degrees forearm rotation, and 73% grip strength compared with the opposite limb. In the treatment of malaligned, ununited f ractures of the distal radius, specific techniques and implants must be tai lored to the deformity of the distal radius and the shape of the distal fra gment. A stable, well-aligned wrist with preservation of at least 50 degree s mobility in flexion and extension was achieved in every patient, but the final result was compromised by associated problems in 3 patients. (J Hand Surg 2001;26A:201-209. Copyright (C) 2001 by the American Society for Surge ry of the Hand.).